Pills for Cheap

What causes the galea to become thick? Why do men become bald but not women?

Dr. Engstrand stated that the thickening of the tendinous scalp membrane is effected by the male sex hormones. He indicated several other possible causes for this condition, but the main cause is hormone stimulation. Men with a generous sex hormone production have a greater chance of losing their hair. This explains the typical male pattern of baldness: bald head but otherwise vigorous secondary male sex characteristics—thick, fast-growing beard and abundant hail’ growth on the other parts of the body.

A hereditary tendency is also indicated. Not only is there a great variety in the quantity of sex hormones produced by different men, but even the amount of blood which each individual, anatomically speaking, has available for his scalp, varies considerably from man to man and is hereditary to some extent. Also, Dr. Engstrand stressed the fact that hormone production and stimulation can vary to a great extent during different periods and various ages of the same individual. In addition, excessive hair loss can be influenced by such factors as nutritional deficiencies and prolonged mental or emotional stress. Mental stress causes tensions in the muscle tissues of the scalp and the neck and thus constricts the blood vessels.

How Dr. Engstrand’s theory was proven

Dr. Engstrand developed a special surgical method which he calls The Radical Scalp Operation According to Engstrand. The operation is aimed at relieving the pressure in the scalp by making several incisions in the galea. It is a simple operation without hospitalization which takes about 50 minutes to perform. Dr. Engstrand has performed over 1,000 such operations and reports quite remarkable results. In the most favorable group of patients, between 70 and 80 percent experienced increased hair growth within six months to a year. Even in completely bald areas—in the recessed temples and at the crown of the head—his method has brought new hair growth in 40 to 50 percent of the patients, provided that the baldness was of a shorter duration than five years.

Thus, Dr. Engstrand has definitely proven that loss of hair and baldness is indeed caused by impaired blood circulation. Whether or not the surgical approach is the right and most effective way to increase blood distribution to the hair follicles remains to be seen. In accord with the spirit of this book, which is basically a self-help book, I am inclined to think that there are easier ways than operations to stimulate the increased blood flow to the hair roots. I am referring to the nutritional approach. And in this regard I have very exciting news for you.

*107\58\2*

Stomach and intestines have their iris positions in the first major zone, directly around the pupil. In contrast to the other organs they are concentrically arranged, and take in a third of the iris.

When looking at an iris, attention is first directed to the stomach and intestinal zones. In health the stomach and intestinal zones are of equal size. They take in a third of the iris and do not differ in essential colour and structure from each other. This normal form of the first major zone is very seldom found in these days.

Disturbances of the intestines are recognised in the course and colour of the iris-wreath.

1. Dilatations of the iris-wreath are often seen. If roundish, they suggest an intestinal atony, and these usually stem from incompletely cleared catarrhs of childhood. Dark spots in the dilatations are indications that the intestinal glands are no longer functioning. Patients with these signs had many colicky pains as children, with a history of always wanting to drink cold water ( = intestinal scrofula).

If the signs are more honeycomb-like, then one speaks of’ ‘wormnests’. That is to say, that the patients have suffered from worms. If worms are suspected, then other signs are searched for: undue activity of the pupils, dark rings under the eyes, signs of worms on the tongue, in the nose, and itching of the anus, etc.

Pointed white spokes of the iris-wreath which take in the second large zone are signs of intestinal colic.

2. A white iris-wreath is an indication for inflammation of the intestines. This inflammation often extends over into the lymph channels, to the fifth minor zone (mucous membrane zone). One can then observe thick radiating white lines from the wreath to the fifth minor zone, in which white clouds or flakes also appear.

3. A contraction of the iris-wreath arises because of pressure from the outside, and can be caused by organ displacement (e.g. floating kidney, enlarged liver) or by a tumour. A downward depression of the wreath is a sign of ptosis of stomach or intestines.

4. An expansion of the large intestine field in the direction of the heart area (left iris 10′-15′, right iris 45′-50′) enables one to diagnose ‘Roemheld’.

5. Tumour and cancer signs.

6. All iris signs which originate from the pupil and traverse the iris-wreath indicate a participation of the central nervous system in the disturbed condition.

7. If in the left iris one finds an iris-wreath with a pointed serrated margin, a sign of weakness in the heart area, and an adrenal sign, then a vegetative dystony is indicated. The patient is full of inner disturbances, with troubles here and there, without it being possible to define a clinical condition.

8. A square-shaped wreath always indicates a grave and incurable condition. Pancreas signs are always then to be found.

9. The appendix area lies in the right iris—from 33′-35′, directly at the wreath. In inflammatory states there shows a white sign = acute condition, or a yellow sign = chronic condition. One often observes in this area signs of adhesions, which go out from the intestine and reach to the peritoneum. They arise after chronic inflammations, as well as after badly healed appendicectomies, and can produce considerable disturbance.

A black spike in the caecal area signifies that the caecum has become functionally incapable and shrivelled. Black or dark lines which go over or under in an arc, indicate displacement of the caecum. Very often it becomes adherent to the gall-bladder, peritoneum, ovary, Fallopian tube, etc.

10.Strong dilatations of the intestinal zone from 25′-30′ in the left iris and from 30-35′ in the right iris, enable one to recognise the tendency to hernia. The iris-wreath is broken through at the point where the rupture ensues. If pain also appears, then white clouds in this area will point to an inflammatory state.

Small lacunae inside the iris-wreath indicate a disturbance in the gastro-intestinal secretions, arising from atony of the stomach and intestine musculature.

11.Special attention should be directed to the S. Romanum (Sigmoid flexure) and to the rectum. In many cases, the area for rectum, left iris 32-34′, shows a white discharge-sign, as an indication of mucous membrane catarrh. Often, the iris fibres in this area separate from one another, and indicate a sign of commencing weakness ( = atonic constipation).

Signs for haemorrhoids are seen in this area in the form of small dark spots. Apart from this, one not infrequently observes a very dark brown neurasthenic ring, and indications of stasis in the liver area, as symptoms of a portal congestion. With haemorrhoids, one usually finds very wrinkled eyelids. Interrogation reveals that these patients must often rub their eyes because they feel as if there were sand in them. A later indication of haemorrhoids is the presence of 2 red fleck in the lower eyelid. The more this fleck lies temporalwards, then the more analwards lie the haemorrhoids. The more it lies nasalwards, then the higher they lie.

*16\78\2*

In order to be protected against these three diseases, infants must receive three injections of the combined DTP (diphtheria, tetanus, pertussis) vaccine by the age of six months. The first injection is given at two months, followed by two more administered every other month. The child must receive a booster shot of CDT (combined diphtheria and tetanus toxoid) at age 18 to 24 months and another CDT shot at the age of four to six years. Thereafter, a booster of diphtheria-tetanus vaccine is necessary every ten years for life.

Diphtheria. Diphtheria is a bacterial disease that is frequently fatal. It causes infection of the nose, throat, tonsils, and lymph nodes of the neck. The bacterium responsible can produce a toxin (poison) that causes heart damage and paralysis. Cases of diphtheria are now rare in Western countries. For every case reported there are many other persons who are carriers of diphtheria. (A carried is a person who harbors the disease without getting sick him- or herself, and who can transmit it to other people.)

Before the diphtheria vaccine came into general use 40 years ago, many adults were immune to diphtheria because they had had some form of the illness in childhood. This situation no longer exists, so adults should receive booster shots of diphtheria vaccine every ten years. Serious ractions to the diphtheria vaccine, which is a dead vaccine, are rare.

Tetanus. Tetanus, or lockjaw, is a disease of the nervous system that can enter the body through a wound – even a minor wound like a scratch or an insect bite. Tetanus cases still occur throughout Australia. Although the vaccine is thoroughly safe and effective, its protection weakens over the years and booster shots are required. It is generally thought that after the age of four to six a child should receive a booster every ten years. However, some people are likely to have more frequent contact with tetanus germs and need to have a booster shot every five years. In general, clean wounds, such as those from kitchen utensils, require boosters every ten years; dirty wounds, such as those from rusty nails, barbed wire, and others that happen outdoors, require boosters every five years. For example, if your child has a wound from a rusty nail, check to see if he or she has received a booster within the last five years. Adults should receive boosters at least every ten years.

Whooping cough. Whooping cough is more common than many parents (and doctors) realize. It is a highly contagious infection of the respiratory tract, and it gets its name from the severe, strangling cough that develops as the disease progresses. Whooping cough vaccine is the most uncertain of the three components of the DTP vaccine, and it does not always give complete immunity. There have been extremely rare instances of brain damage following its use, but in some of these cases the damage was caused by faulty administration of the vaccine rather than by the vaccine itself. The vaccine may also cause a brief reaction of fever. For these reasons, routine boosters are not recommended after the child is eighteen months old. However, the mortality rate among infants under age one who contract whooping cough and the possibility of complications in older children are high enough to exceed by far the minimal risk of the vaccine.

In England, serious reactions to the vaccine were sufficiently frequent at one point to persuade the medical profession to suspend its use. However, because of the increasing incidence of whooping cough and its severe complications, immunization has now been reinstituted in England.

*262/84/5*

Appendicitis is an inflammation (infection) of the appendix. The appendix is a hollow tube about the size of your little finger that forms a blind pouch where the small intestine joins the large intestine. In 99 percent of all children, the appendix lies in the lower right quarter of the child’s abdomen.

Appendicitis can occur at any age. If the appendix is not surgically removed, the infection worsens until the appendix bursts. Then the infection spreads throughout the abdomen. An infected appendix may perforate (rupture) within hours of the initial pain or may not rupture for a day or two. A ruptured appendix can lead to death.

Signs and symptoms

Persistent abdominal pain in your child should be considered a symptom of appendicitis until proven otherwise. Typically, the pain of appendicitis is constant; it does not come and go as does the pain from cramps. Once it starts, it grows continually worse. The pain may start in the pit of the stomach, but it usually soon moves to the lower right quarter of the abdomen. The pain is made worse by walking or just moving about. The abdomen is tender to a gentle pressure in the lower right quarter, more tender than in other areas. There may be nausea and vomiting, but these symptoms usually start only after the pain has started.

Generally, there is a low-grade fever (37.8°C, oral; 38.3°C, rectal), but the temperature may range anywhere from normal to 40°C. Bowel movements are usually normal, but there may be diarrhea. Diagnosis is difficult because all of these signs may not be present. Because diagnosis is so difficult and the condition is so serious, call your doctor if you have any reason to suspect appendicitis.

Home care

Try applying gentle heat, as with a heating pad turned to “low.” If pain gets worse, it is probably appendicitis. Never apply cold; this can mask the symptoms of appendicitis.

Do not give pain killers such as paregoric or codeine. Acetaminophen is safe but useless. Aspirin can affect the blood’s ability to clot, so it should not be given in case the child needs surgery. Allow only clear liquids by mouth. However, once you suspect that there is a strong possibility of appendicitis, do not give your child any food or drink until you consult your physician. Never give a laxative or enema.

Precaution

If pain persists in the lower right quarter of the abdomen, despite home treatment measures, call your doctor.

Medical treatment

The only acceptable treatment for appendicitis is surgical removal of the appendix (an appendectomy). Therefore, your doctor must be reasonably sure of the diagnosis. In addition to the abdomen, your child’s chest and throat will be examined because a throat infection and pneumonia can cause symptoms of appendicitis. A rectal examination will also be performed and a blood count and a urinalysis done. (These last two tests do not prove or disprove appendicitis, however.) An X ray may be called for.

Once tests are complete, your doctor may operate or admit your child to a hospital to watch the child for a few hours until the diagnosis becomes more certain. Unnecessary surgery is to be avoided, but the rule of safety is to operate on a child who may have appendicitis rather than postpone surgery until the appendix ruptures.

*16/84/5*

Comic actor John Candy. Professional baseball player Nolan Ryan. At age 43, both hit milestones in their lives. One had just pitched two no-hitters, putting the finishing touches on a glorious major-league career that spanned 27 years. The other smoked and had a weight problem and was dead of a heart attack. Sometimes our destiny isn’t in our hands. But sometimes it is.

Lots of guys point their fingers at the fates when talking about their health, says Walter M. Bortz II, M.D., clinical associate professor of medicine at Stanford University School of Medicine and author of Dare to Be 100. Or worse, they believe that coming from “good stock” gives them license for self-abuse. The truth is that our genes generally have less to do with how long we live than we’d like to believe, says Dr. Bortz. “Genetics have about a 20 percent influence on life span,” he says. “The rest is in your hands.”

“The length of your life is hugely affected by your lifestyle,” agrees Dr. George Webster, researcher in molecular biology and aging. “Lots of people today are living a hell of a long time because they’re finally doing what they ought to be doing-not smoking, getting out of their chairs, and becoming more active.” Here are the top seven behaviors experts say will shorten your life and what you can do about them.

The Meat-and-Potato Men

Sixty-nine percent of men admit that they struggle with eating a balanced diet. Most of us eat about 10 percent more than the 30-percent-calories-from-fat-a-day plan we’re supposed to stick to. We’re eating a measly three or four servings of fruits and vegetables each day instead of the five to nine the U.S. Department of Agriculture Food Guide Pyramid recommends. And about one-third of men are overweight. “Then we’re surprised when our health gives out,” Dr. Webster says.

“We need to and can do much better,” says Ken Goldberg, M.D., founder and director of the Male Health Institute in Dallas and author of How Men Can Live As Long As Women. “The key is to follow a healthy diet most of the time, so you can have nachos and beer at the ball game and it won’t matter.” Here’s what experts recommend.

Eat just one. If each time you eat, you include a fruit or a vegetable, you’ll steadily improve your health, says Dr. Goldberg. The 30-year Framingham Heart Study by Harvard researchers found that with each additional serving of fruits and vegetables that 832 men ages 45 to 65 ate, the lower their risk of stroke became. And that’s only one benefit. Eating more fruits and vegetables also lowers your risk for colon cancer and heart disease, adds Dr. Goldberg.

Get the red out. When faced with a choice in meats, choose fish, turkey, or chicken, Dr. Goldberg says. A landmark study of close to 48,000 male health professionals found that men who ate the most red meat had a significantly higher risk for advanced prostate cancer than those who ate the least.

Stop, drop, and live. A side benefit of eating more fruits and vegetables and less fatty red meat is that you’ll also likely shed a few pounds, says Dr. Goldberg. Even the least bit of waist-whittling can add to your life. In another landmark, 22-year study of nearly 20,000 men, researchers found that being just 2 to 6 percent over your ideal weight increases your risk for cardiovascular disease. Being as much as 20 percent over increases your risk by more than 2Ó2 times that of ideal-weight men.

*8/36/5*

Case 1

A grossly obese 41 year old male was admitted to hospital for knee surgery. He lived alone in a small unit, was unemployed, had no interest in outdoor activities or hobbies and had very poor dietary habits. At 180 Kg, with high blood pressure and a failing heart he was not a good candidate for anesthesia. It was decided to seek the opinion of a respiratory specialist when nursing staff and fellow inpatients complained of his loud and unrestrained snoring and it was with obvious relief that he was transferred to the sleep unit. Overnight studies demonstrated severe sleep apnoea with both obstructive and central components. He was fitted with a nasal CPAP mask which greatly improved his nocturnal oxygenation but surgery was still considered too great a risk for such a patient. He was advised to continue nasal CPAP at night for the remainder of his time in hospital to familiarize himself with the procedure for home use. He was discharged from hospital following a thorough assessment of his heart disease and blood pressure, and placed on a strict weight reduction diet. The man was seen a month later in an outpatient clinic. He had reverted to his previous eating habits, put back on the small amount of weight lost during hospitalization and had discontinued the use of CPAP. He could not be convinced of its benefits and remains untreated for this serious condition.

Comment: An unmotivated patient with this sort of medical history can only expect further deterioration. It takes some time to become accustomed to CPAP, but failing that there should at least be an urgent reappraisal of one’s lifestyle.

Case 1

After many years of recurring tonsillitis in a 7 year old girl, her parents had reached the point of desperation. This first manifested itself as snoring when the child was about 18 months old but a pediatrician assured the parents that the young girl would eventually grow into her large tonsils. Sleep related snoring and occasional episodes of tonsillitis marked the early years of her life until she was 4 years old when her mother became aware of times when the child seemed to be struggling for breath. In retrospect, judging by a description of events in the following years, the child had developed OSA, the consequences of which were to disrupt the life of parents and child for a further three years. Severity of the child’s airway obstruction no doubt reflected the status of the child’s tonsils. At best there was always a degree of snoring but a common cold or any inflammation of her tonsils would guarantee a succession of traumatic nights; traumatic for the child who would awake several times a night crying and further complicated by instances of bed-wetting and falling out of bed. It was also traumatic for the parents who were anxious about their daughter’s distress at night, not to mention the considerable disruption to their own sleep. Antibiotics probably helped to minimize the duration of these episodes but it was becoming increasingly clear that prescription of these medications was not addressing the underlying problem.

For a girl of above average ability, she was not progressing as well as could be expected and frustrated teachers would report on her tiredness and lack of application. The parents finally sought help from a pediatrician with some expertise in sleep apnoea. A hospital admission and overnight studies documented airway obstruction and oxygen desaturation consistent with OSA. Tonsils and adenoids were surgically removed a month later and the results were immediately apparent. Snoring was virtually abolished and her parents no longer had to comfort a distressed child at night, indicating an improvement in sleep quality and although she still experiences occasional colds and upper respiratory tract infections, heavy snoring and complete airway obstruction has never reoccurred.

Comment: Disruption of home and school life could have been avoided with earlier detection of OSA.

*16/51/5*

Preventive medicine can be divided into three categories.

Primary prevention involves the removal of causes so that the condition doesn’t occur in the first place. Diseases related to smoking are obvious examples here: stop people smoking (primary prevention) and the smoking-related diseases disappear.

Secondary prevention picks up disease before symptoms occur. This is the essence of health screening which, by detecting disease early, can prevent the development of more serious manifestations of the disease. Detecting previously undiagnosed high blood pressure is a good example of this kind of prevention.

Tertiary prevention involves the management of diagnosed disease in such a way as to prevent or limit the development of a disability or to prevent the person dying prematurely. The best example here is diabetes. Diabetics with good tertiary prevention can now live long and near-normal lives.

But what are we aiming for with all the prevention-eternal life? No. Most people, when asked, are happy to settle for a reasonably long lifespan spent in good health. In simple terms medicine over the last hundred years or so has shifted deaths in early years to later life. However, despite a four-fold increase over the last century in the number of men living to be 100 and a nine-fold increase in the number of women living to that age, the proportion is still only one in 1,000 and 5 in 100 respectively. Suggestions that we could all live to 130 or more are as yet somewhat fanciful but we can now reasonably aim to live to about 85 or 90, with few of us dying of disease under the age of 70. If we are to achieve this we have to attack cancers and heart disease, which account for more than half of all life lost under the age of 85, and those few diseases that stand out as special cases. These include diseases associated with the excessive use of alcohol, addictive drugs, motorcycles, cigarette smoking in women and large numbers of sexual partners.

But being healthy is not just a matter of what you do or do not do. It seems that health and long life are often a gift bestowed on a person at conception when they inherit good genes. With the combined effects of healthy habits and good luck many people’s health can be maintained for years with good medical care taking the edge off diseases and accidents. Until fairly recently, living longer usually meant accumulating more and more disorders, diseases and disabilities which, together with social isolation, poverty, failing memory, a loss of purpose, reduced family contacts and other limitations, have led to a vast increase in the numbers of elderly people living out the last years of their lives in residential care. Younger people, seeing this as a depressing future for themselves, are beginning to get concerned-and rightly so. A questionnaire in a Swedish magazine in 1971 asked readers how they most wanted to did A large majority said they wanted to pass away quickly and without worrying. So, ironically, what we are all trying so desperately to prevent-heart disease – appears to be exactly what, in one form, many of those ‘at risk’ most want to die from. But as in the old monk’s prayer-’Dear Lord, give me patience; but give it to me now’-we can’t choose when this sudden and quick form of death will take us. None of us would mind dying like this in our seventies or eighties but the tragedy is that increasing numbers of men in their forties or fifties are losing their lives in this way.

Some people worry about the long-term effects of a population with an ever increasing proportion of ever older people, and they have a point which has to be taken seriously by those who try to prolong life at almost any price. Viewed in the widest possible socio-economic perspective, the gradual move from a three-generation society to a four-generation one is likely to produce increasing strain between the productive and reproductive groups and those who are mainly ‘takers’ from society. Our industrial society cannot find enough jobs for its working-age people, let alone the elderly. So we could soon see countless millions of pensioners in the western world with many years of life to live but with nothing to do.

No one would dispute the benefits preventive medicine has brought in the earliest part of life but, some people are asking, should it be allowed to do the same for the other end of the life scale – at least in those societies where already those who reach middle age tend to live into their eighties? All of this may appear somewhat pessimistic but it could well be that within the reasonably near future the elderly will be taking up so much of the nation’s resources that curative medicine for the productive sector of society will be seriously put at risk. There are those who would say that this is already happening, at least to some extent.

*16/72/5*

Although the time will come in the course of most forms of dementia when sufferers will become less involved with their environment and those around them because of apathy, loss of concentration, and so on, it is best to make the most of what they can achieve while this is still possible. Life will then become fuller not just for the sufferer, but also for those who are involved in caring. This chapter describes some simple activities that may be possible in the early and mid stages of the disease. Rather than trying to keep a person with dementia active all day long, it is probably better to break up the day by organizing several short periods of activity at convenient times. In the earlier stages of the disease it may be helpful to concentrate upon those that will result in the sufferer enjoying a feeling of achievement and of having been useful.

Other important areas that relate to the preservation of independence are the need to stop driving, to give up work, to give up living alone, and often to move house. These will all be discussed in turn.

It is not usually possible for people with dementia to learn new skills so it is best to base activities, whether recreational or otherwise, on skills that have already been obtained in earlier life, taking advantage of them until they fade from the memory store. Activities that involve relationships with other people and pets are often among the most meaningful for a person with a declining intellect. It is also important to remember the need for physical exercise.

This chapter will only be able to provide ideas, as with so many of the other chapters in this book. Trial and error alone will show what is best for an individual and his or her pattern of activity should not be expected to remain unchanged as the months pass.

*99\138\2*

As a dementing illness progresses, relatives and, to a lesser extent, friends have to come to terms with the loss of someone they love. Although this process is a slow one, starting with the realization that the sufferer is not the person he or she used to be, and progressing to a loss of companionship and a hundred and one other losses, it is very much akin to the grief and bereavement experienced after someone has died. Although the body is physically still present, the personality goes. This is particularly painful when the sufferer is unable to communicate with, understand, or recognize you. This sense of loss is very difficult to cope with sometimes, and the long-drawn-out grieving process may affect the pattern of bereavement when the sufferer eventually dies. Just as you come to terms with the situation, your relative may deteriorate in another way and you have to adjust all over again.

With a progressive illness like dementia, the grief can get worse as time goes on and very often death is a merciful release from this type of emotional turmoil, just as it is from the physical burdens and the distressful existence of the sufferer. Many people won’t understand what you are going through. We can all relate to the recently bereaved, but this is a situation that is only really understood by others who have experienced it, either first hand or by working closely with those in your position. As for so many of the emotional problems that arise when caring for a person with dementia, the main anchor in coping with the living bereavement process can only be a sharing of the experience with others. There is little to be gained from keeping a stiff upper lip and maintaining a facade of emotional independence.

*77\138\2*

A young person with suspected dementia will probably first be referred to a neurologist. This is a doctor who has been specially trained in the diagnosis and treatment of disorders of the nervous system, including the brain. Neurologists ensure that a thorough physical examination is undertaken, having carefully inquired into the history of the illness, and will arrange appropriate tests, including blood tests and special X-rays. However, after making a diagnosis, many will not be in a position to offer any regular help and will refer the continuing management of the patient back to the general practitioner.

An older person with dementia is more likely to be referred to a geriatrician or a psychiatrist with a special interest in the elderly, sometimes called a psychogeriatrician. Geriatricians are trained in all the disorders that are found more commonly in older people. They will perform a very similar assessment to that provided by the neurologist for younger people, but will also have access to many of the health service resources that are essential for the continuing care and support for people with dementia, and for their relatives and carers.

As well as hospital beds to provide intermittent relief or holiday admissions the geriatric department usually has a day hospital. This is not necessarily a facility for providing relief for families, but an environment in which further careful assessment can be undertaken. In most cases there has to be a ‘therapeutic’ need for a person to attend a day hospital. Day relief is provided elsewhere, for example at day centres run by the statutory and voluntary services.

Although there are no strict rules, elderly people with dementia who require screening are generally referred first to a geriatrician, but after this the care for those who are mobile as well as demented usually falls to the psychogeriatrician. There are good practical reasons for this; for instance, psychiatric day hospitals are more secure and a wandering demented person is less likely to escape and come to harm. On the other hand a demented person who is heavily dependent on physical nursing will more usually need the help of the geriatric service. There are of course many exceptions to this generalization.

Very often psychogeriatricians will visit patients in their own home, and take the opportunity to familiarize themselves with the problems that relatives and other carers are having to manage. In this way they can judge how best the resources that they have available can help. It also allows those looking after a person with dementia to demonstrate the difficulties they are facing and being able to talk about the problem in their home environment is often easier than trying to describe the situation in a busy out-patient clinic.

Once the matters of diagnosis and assessment have been completed, the specialist will plan the future with the family, the general practitioner, and often other members of his team. It is important that everybody knows about this ‘package’ so that they can see the way ahead. One must also remember that the package has to be regarded flexibly and its provisions may need to be changed as the situation alters.

In some parts of the country there are specialist clinics for people with dementia where a person with dementia isn’t just seen in a slot between people with other conditions, but is assessed in an environment in which all patients have similar problems and all staff are specially trained in this area of medicine. The pattern in different memory clinics varies, but in some every patient is seen by a geriatrician, a psychiatrist, and a psychologist, and great attention is paid to the problems and needs of the carers. (A psychiatrist is a doctor trained in the problems of mental illness; a psychologist, although not medically qualified, is trained in the skills of behaviour assessment, behaviour treatment, and other related activities; he is also able to give valuable advice.) A full appraisal of the medical problems is made, a diagnosis of the underlying disorder is established, and treatment is prescribed for the fortunate few with a treatable underlying condition. The way ahead is mapped out and the patients and their families seen regularly two or three times a year. The day to day management of patients’ care is returned to the general practitioner or to the local specialist if they have been referred from another area of the country. The clinic may also have a support group attached to it for the families of people with dementia who live in the district. The number of clinics like this is increasing and, if one is available locally, your general practitioner will probably seek from it a second opinion. One of the major strengths of such clinics is that they often have a representative of both the geriatric and the psychogeriatric services, allowing closer collaboration between the two in dealing with the needs of a particular person.

*55\138\2*